{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T07:35:01Z","timestamp":1780731301061,"version":"3.54.1"},"reference-count":23,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T00:00:00Z","timestamp":1664928000000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Coegin Pharma AB","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,9,20]]},"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Actinic keratosis (AK) is the most common precancerous skin condition caused by long-term UV exposure. Given the high recurrence rate of 15%\u201353%, identifying safe and effective treatment options is warranted. AVX001, a cytosolic phospholipase A\n                      <jats:sub>2<\/jats:sub>\n                      \u03b1 (cPLA\n                      <jats:sub>2<\/jats:sub>\n                      \u03b1) enzyme inhibitor, is a novel anti-inflammatory drug for field-directed, self-administered, topical therapy of AK.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This study is a single-centre, randomised, vehicle-controlled, double-blind, parallel-group hybrid clinical trial in adults with multiple AK lesions Olsen grade 1 or 2. The hybrid design combines decentralised participant tasks and assessments with conventional in-clinic visits. Recruitment using targeted advertising on social media and eligibility prescreening are conducted via the Studies&amp;Me online recruitment platform. Participants (n=60) are randomly assigned to 1 of 3 treatment arms: AVX001 gel 1%, AVX001 gel 3% or vehicle gel. The trial consists of a 4-week treatment period with daily field-directed topical application of the gel and an 8-week follow-up period. Participants attend in-clinic visits at baseline, week 4 and week 12. The remote participant trial tasks include questionnaires and upload of smartphone-obtained photos of the treated skin area using a study-specific web-based app. Both remote and in-clinic assessments of safety and efficacy will be performed. The primary objective is to evaluate the local tolerability of daily application of AVX001 gel (1% or 3%) compared with vehicle gel. Secondary objectives include safety, efficacy, dose\u2013response efficacy relationship, treatment satisfaction and cosmetic outcome. Exploratory objectives include evaluations of tolerability and efficacy assessed by dermatologists using smartphone photos uploaded by participants, comparisons of in-clinic and remote assessments and assessment of AK-related skin changes by non-invasive optical imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Approved by the Ethics Committee of the Capital Region of Denmark (H-21018064) and the Danish Medicines Agency (2021032485). Results will be submitted for publication in peer-reviewed scientific journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration numbers<\/jats:title>\n                    <jats:p>\n                      2021-000934-32;\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05164393\">NCT05164393<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-061012","type":"journal-article","created":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T12:14:43Z","timestamp":1664972083000},"page":"e061012","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["The Copenhagen Actinic Keratosis Study (COAKS). A decentralised clinical trial to evaluate tolerability, safety and efficacy of daily field-directed topical treatment with cytosolic phospholipase A\n                    <sub>2<\/sub>\n                    inhibitor, AVX001, in participants with actinic keratosis: protocol for a randomised controlled phase I\/IIa trial"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct05164393","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9708-6717","authenticated-orcid":false,"given":"Vinzent Kevin","family":"Ortner","sequence":"first","affiliation":[{"name":"Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1901-7614","authenticated-orcid":false,"given":"Berit","family":"Johansen","sequence":"additional","affiliation":[{"name":"Clinical Operations, Coegin Pharma AB, Lund, Sweden"},{"name":"Department of Biology, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Kilov","sequence":"additional","affiliation":[{"name":"Studies&Me, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Castillo Mondrag\u00f3n","sequence":"additional","affiliation":[{"name":"Studies&Me, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tore","family":"Duvold","sequence":"additional","affiliation":[{"name":"Clinical Operations, Coegin Pharma AB, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesper","family":"Kihl","sequence":"additional","affiliation":[{"name":"Clinical Operations, Coegin Pharma AB, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicity J","family":"Ashcroft","sequence":"additional","affiliation":[{"name":"Clinical Operations, Coegin Pharma AB, Lund, Sweden"},{"name":"Department of Biology, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5559-2072","authenticated-orcid":false,"given":"Astrid J","family":"Feuerherm","sequence":"additional","affiliation":[{"name":"Clinical Operations, Coegin Pharma AB, Lund, Sweden"},{"name":"Department of Biology, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2851-6482","authenticated-orcid":false,"given":"Charlotte","family":"Pind Laugesen","sequence":"additional","affiliation":[{"name":"Studies&Me, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1042-7342","authenticated-orcid":false,"given":"Maiken Lise","family":"Marcker Espersen","sequence":"additional","affiliation":[{"name":"Studies&Me, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3323-102X","authenticated-orcid":false,"given":"Ionela","family":"Manole","sequence":"additional","affiliation":[{"name":"Second Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7957-6285","authenticated-orcid":false,"given":"Ari Pall","family":"Isberg","sequence":"additional","affiliation":[{"name":"Studies&Me, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4784-0010","authenticated-orcid":false,"given":"Anders 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